The Relevance of Including Future Healthcare Costs in Cost-Effectiveness Threshold Calculations for the UK NHS

Overview

Journal Pharmacoeconomics

Specialty Pharmacology

Date 2021 Oct 26

PMID 34697717

Citations 4

Authors

Megan Perry-Duxbury

James Lomas

Miqdad Asaria

Pieter van Baal

Affiliations

Soon will be listed here.

Abstract

Background And Objective: The supply-side threshold for the UK National Health Service has been empirically estimated as the marginal returns to healthcare spending on health outcomes. These estimates implicitly exclude future healthcare costs, which is inconsistent with the objective of making the most efficient use of healthcare resources. This paper illustrates how empirical estimates of the threshold within healthcare can be adjusted to account for future healthcare costs.

Methods: Using cause-deleted life tables and previous work on future costs in England and Wales, we illustrate how such estimates can be adjusted.

Results: While the effect of including future healthcare costs can have substantial effects on incremental cost-effectiveness ratios of specific life-extending interventions, we find that including future costs has relatively little impact (an increase of £743 per quality-adjusted life-year) on the threshold estimate.

Conclusions: For some life-extending interventions the impact of including future costs on whether an intervention is deemed cost effective may be considerable.

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References

Rappange D, van Baal P, van Exel N, Feenstra T, Rutten F, Brouwer W . Unrelated medical costs in life-years gained: should they be included in economic evaluations of healthcare interventions?. Pharmacoeconomics. 2008; 26(10):815-30. DOI: 10.2165/00019053-200826100-00003. View

Kellerborg K, Perry-Duxbury M, Vries L, van Baal P . Practical Guidance for Including Future Costs in Economic Evaluations in The Netherlands: Introducing and Applying PAID 3.0. Value Health. 2020; 23(11):1453-1461. DOI: 10.1016/j.jval.2020.07.004. View

Brouwer W, van Baal P, van Exel J, Versteegh M . When is it too expensive? Cost-effectiveness thresholds and health care decision-making. Eur J Health Econ. 2018; 20(2):175-180. DOI: 10.1007/s10198-018-1000-4. View

Vallejo-Torres L, Garcia-Lorenzo B, Castilla I, Valcarcel-Nazco C, Garcia-Perez L, Linertova R . On the Estimation of the Cost-Effectiveness Threshold: Why, What, How?. Value Health. 2016; 19(5):558-66. DOI: 10.1016/j.jval.2016.02.020. View

Schwarzer R, Rochau U, Saverno K, Jahn B, Bornschein B, Muehlberger N . Systematic overview of cost-effectiveness thresholds in ten countries across four continents. J Comp Eff Res. 2015; 4(5):485-504. DOI: 10.2217/cer.15.38. View

van Baal P, Morton A, Brouwer W, Meltzer D, Davis S . Should cost effectiveness analyses for NICE always consider future unrelated medical costs?. BMJ. 2017; 359:j5096. DOI: 10.1136/bmj.j5096. View

Martin S, Rice N, Smith P . Does health care spending improve health outcomes? Evidence from English programme budgeting data. J Health Econ. 2008; 27(4):826-842. DOI: 10.1016/j.jhealeco.2007.12.002. View

Perry-Duxbury M, Asaria M, Lomas J, van Baal P . Cured Today, Ill Tomorrow: A Method for Including Future Unrelated Medical Costs in Economic Evaluation in England and Wales. Value Health. 2020; 23(8):1027-1033. DOI: 10.1016/j.jval.2020.05.006. View

Meltzer D . Accounting for future costs in medical cost-effectiveness analysis. J Health Econ. 1997; 16(1):33-64. DOI: 10.1016/s0167-6296(96)00507-3. View

10.

van Baal P, Meltzer D, Brouwer W . Future Costs, Fixed Healthcare Budgets, and the Decision Rules of Cost-Effectiveness Analysis. Health Econ. 2014; 25(2):237-48. DOI: 10.1002/hec.3138. View

11.

Eckermann S, Pekarsky B . Can the real opportunity cost stand up: displaced services, the straw man outside the room. Pharmacoeconomics. 2014; 32(4):319-25. DOI: 10.1007/s40273-014-0140-3. View

12.

Martin S, Rice N, Smith P . Comparing costs and outcomes across programmes of health care. Health Econ. 2011; 21(3):316-37. DOI: 10.1002/hec.1716. View

13.

Maynard A, Bloor K . The economics of the NHS cancer drugs fund. Appl Health Econ Health Policy. 2011; 9(3):137-8. DOI: 10.2165/11585750-000000000-00000. View

14.

de Vries L, van Baal P, Brouwer W . Future Costs in Cost-Effectiveness Analyses: Past, Present, Future. Pharmacoeconomics. 2018; 37(2):119-130. PMC: 6386050. DOI: 10.1007/s40273-018-0749-8. View

15.

Morton A, Adler A, Bell D, Briggs A, Brouwer W, Claxton K . Unrelated Future Costs and Unrelated Future Benefits: Reflections on NICE Guide to the Methods of Technology Appraisal. Health Econ. 2016; 25(8):933-8. DOI: 10.1002/hec.3366. View

16.

Appleby J, Devlin N, Parkin D, Buxton M, Chalkidou K . Searching for cost effectiveness thresholds in the NHS. Health Policy. 2009; 91(3):239-45. DOI: 10.1016/j.healthpol.2008.12.010. View

17.

Raftery J . NICE's cost-effectiveness range: should it be lowered?. Pharmacoeconomics. 2014; 32(7):613-5. DOI: 10.1007/s40273-014-0158-6. View

18.

van Baal P, Perry-Duxbury M, Bakx P, Versteegh M, van Doorslaer E, Brouwer W . A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending. Health Econ. 2018; 28(1):87-100. PMC: 6585934. DOI: 10.1002/hec.3831. View

19.

Claxton K, Martin S, Soares M, Rice N, Spackman E, Hinde S . Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015; 19(14):1-503, v-vi. PMC: 4781395. DOI: 10.3310/hta19140. View